A goiter is an enlargement of the thyroid. The thyroid is a gland. It produces hormones that help regulate your body’s metabolism. It is located on the front of the neck, right below the Adam’s apple. Goiters are seldom painful. They tend to grow slowly.
There are different types of goiters. This sheet focuses on nontoxic (or sporadic) goiter. It is a type of simple goiter that may be:
- Diffuse—enlarging the whole thyroid gland
- Nodular—enlargement caused by nodules, or lumps, on the thyroid
The development of nodules marks a progression of the goiter. It should be evaluated by your doctor.
The exact causes of nontoxic goiter are not known. In general, goiters may be caused by too much or too little thyroid hormones. There is often normal thyroid function with a nontoxic goiter. Some possible causes of nontoxic goiter include:
- Family history of goiters
- Regular use of medications such as lithium, propylthiouracil, phenylbutazone, or aminoglutethimide
- Taking a lot of substances (goitrogens) that inhibit production of thyroid hormone—common goitrogens include foods such as cabbage, turnips, Brussels sprouts, seaweed, and millet
- Iodine deficiency—Iodine deficiency is rare in the United States and other developed countries, due to the use of iodized table salt; this is a primary cause of goiter in other parts of the world, particularly in mountainous areas, or areas that experience heavy rainfall or flooding
Nontoxic goiter is more common in women and in people over age 40.
The following factors increase your chance of developing nontoxic goiter:
- A diet low in iodine
- Family history of goiter
- History of radiation therapy to head or neck, especially during childhood
Nontoxic goiters usually do not have noticeable symptoms, unless they become very large. Symptoms may include:
- Swelling of the neck
- Breathing difficulties, coughing, or wheezing with large goiter
- Difficulty swallowing with large goiter
- Feeling of pressure on the neck
You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may recommend a specialist. An endocrinologist focuses on hormone related issues.
Your body fluids and tissues may be tested. This can be done with:
- Blood tests
- Fine needle aspiration biopsy
Images may be taken of your body structures. This can be done with:
Nontoxic goiters usually grow very slowly. They may not cause any symptoms. In this case, they do not need treatment.
Treatment may be needed if the goiter grows rapidly, affects your neck, or obstructs your breathing.
If a nontoxic goiter progresses to the nodular stage, and the nodule is found to be cancerous, you will need treatment. Talk with your doctor about the best plan for you. Treatment options include the following:
Hormone Suppression Therapy
Thyroid hormone medication is used to suppress secretion of thyrotropin (TSH). TSH is the thyroid-stimulating hormone that causes growth. This therapy is most effective for early stage goiters that have grown due to impaired hormone production. It is less effective for goiters that have progressed to the nodular stage.
Radioactive iodine treatment is used to reduce the size of large goiter. It is used in the elderly when surgical treatment is not an option.
A surgery to remove a portion or all of the thyroid gland. It is the treatment of choice if the goiter is so large to cause difficulty in breathing or swallowing.
- Reviewer: Kim A. Carmichael, MD, FACP
- Review Date: 12/2014 -
- Update Date: 12/20/2014 -